To TPLO or not to TPLO. . .
September 26, 2007 7:08 PM Subscribe
Veterinary Opinion Filter. Meeting with an orthopedic specialist next Tuesday to discuss partial tear of our 7.5-year old boxer's cranial cruciate ligament (rear right) and potential partial tear of the left as well. What are the right questions to ask the vet and are there any feasible alternatives to TPLO surgery?
Riley is about 55 pounds and, apart from these apparent tears, is the "picture of health" according to her vet. We brought her in after she started favoring her rear left leg over the last few weeks--usually after a nap or extended period of sitting/lying down. The vet expects that TPLO will be recommended, and admitted that there is a history associated with the procedure (i.e., patents, long-term effects, etc.), which Google confirms. In fact with all of the discussion of TPLO, I haven't found much information about alternatives. This seems like major surgery (as well as a major expense and recovery) for a partial tear. Are there any feasible alternatives? Was this something that dogs were put down for 10 years ago, or something that they just lived with? In short, would appreciate any and all information that will help us make an informed decision.
Riley is about 55 pounds and, apart from these apparent tears, is the "picture of health" according to her vet. We brought her in after she started favoring her rear left leg over the last few weeks--usually after a nap or extended period of sitting/lying down. The vet expects that TPLO will be recommended, and admitted that there is a history associated with the procedure (i.e., patents, long-term effects, etc.), which Google confirms. In fact with all of the discussion of TPLO, I haven't found much information about alternatives. This seems like major surgery (as well as a major expense and recovery) for a partial tear. Are there any feasible alternatives? Was this something that dogs were put down for 10 years ago, or something that they just lived with? In short, would appreciate any and all information that will help us make an informed decision.
My parents' lab had the surgery on his right leg a couple of years ago, for a full tear of the CL. A few weeks ago he started favoring the left, but definitely wasn't in the same kind of pain that he'd been in before. They took him to two vets and the consensus is that he has a partial tear of the ligament in the left leg. The first vet wanted to do the surgery again, but his rates had gone up fifty percent(!) from the operation two years ago and he did no x-rays this time around, so my parents' took the dog for a second opinion. The second vet splinted Buddy's leg and said that if it's not better after a couple of weeks he will have to have the surgery, which is where we stand right now.
I do not think that Riley could just live with it -- if the ligament tears all the way the dog will be in tremendous pain. Often one surgery will follow the other since the dog will always put more weight on the leg that hasn't had a tear, leading to one down the line.
Best of luck to you.
posted by sugarfish at 7:48 PM on September 26, 2007
I do not think that Riley could just live with it -- if the ligament tears all the way the dog will be in tremendous pain. Often one surgery will follow the other since the dog will always put more weight on the leg that hasn't had a tear, leading to one down the line.
Best of luck to you.
posted by sugarfish at 7:48 PM on September 26, 2007
In an active dog, IMO TPLO is really the only way to go. To my knowledge this surgery has the best long-term success rate and results in a very stable joint. I would not consider anything else if this were my dog (unless the ortho vet has a different opinion and a good reason for it). The older methods of repair always had pretty poor success rates long-term by comparison to my knowledge.
Splinting and "waiting to see if it heals" is sometimes acceptable for small dogs, but for large dogs, even partial tears will only rarely bring back truly useful joint stability, which means arthritis, which means decreased mobility and increased use of the other leg (at abnormal stress points to take weight off the bad leg), which very often means a second cruciate injury in the formerly good leg. I would not adopt a wait and see attitude with a dog of this size, you are increasing the chances of ending up with two surgeries to pay for.
There is not necessarily "tremendous pain" from cruciate rupture (we had two at the clinic I work at this past week, and neither were in any obvious large amount of pain - dogs in tremendous pain are generally very obviously in tremendous pain (as in screaming), most cruciate ruptures are uncomfortable and not weight-bearing, but not in severe pain).
Questions I would ask:
- number of surgeries the surgeon has done, and success rates for the respective types he has employed - TPLO is tricky and you want someone who is comfortable with the procedure
- his feelings regarding the older extra/intracapsular repair methods and their suitability or lack thereof for your dog
- I would expect a thorough explanation of the procedure, including how anesthesia is induced, and the mechanics involved (TPLO is a truly amazing thing in terms of how it works from a mechanics standpoint)
- what kind of pain control methods do they use (at least pre-op sedation and intra and post-op analgesia, plus a Fentanyl (or comparable) patch for a day or two, plus pain medication to go home with (opiates plus NSAIDs or comparable). It has been reliably shown that animals recover faster and better if they experience as little pain as possible (just like people), if they tell you that the dog "needs to feel pain" in order to keep quiet, go somewhere less barbaric, many of the pain meds used after major surgeries also have a sedating effect, so there is no need to allow a dog to experience pain post-op.
- what kind of anaesthetic monitoring do they employ (anything less than a dedicated tech anaesthetist and vet assistant responsible for monitoring would concern me - I have seen the levels of monitoring which are available and utilized in the more modern clinics, and I would not have a dog of mine put under anywhere that doesn't have someone whose ONLY job is to monitor vitals and anesthesia levels during the procedure, especially with an older dog). They should at least use a heart monitor and O2 sat monitor, and they should be taking regular blood pressure readings during the procedure.
- can they talk to you/give you a handout regarding post-surgical care so that you can plan appropriately beforehand?
- do they offer/recommend rehabilitation post-op (if not, I would worry)
- they should talk to you about (and you should do your own research into) CareCredit, for big-dollar procedures, you can get no interest for a year in many cases.
Good luck.
More info here.
posted by biscotti at 10:22 PM on September 26, 2007 [2 favorites]
Splinting and "waiting to see if it heals" is sometimes acceptable for small dogs, but for large dogs, even partial tears will only rarely bring back truly useful joint stability, which means arthritis, which means decreased mobility and increased use of the other leg (at abnormal stress points to take weight off the bad leg), which very often means a second cruciate injury in the formerly good leg. I would not adopt a wait and see attitude with a dog of this size, you are increasing the chances of ending up with two surgeries to pay for.
There is not necessarily "tremendous pain" from cruciate rupture (we had two at the clinic I work at this past week, and neither were in any obvious large amount of pain - dogs in tremendous pain are generally very obviously in tremendous pain (as in screaming), most cruciate ruptures are uncomfortable and not weight-bearing, but not in severe pain).
Questions I would ask:
- number of surgeries the surgeon has done, and success rates for the respective types he has employed - TPLO is tricky and you want someone who is comfortable with the procedure
- his feelings regarding the older extra/intracapsular repair methods and their suitability or lack thereof for your dog
- I would expect a thorough explanation of the procedure, including how anesthesia is induced, and the mechanics involved (TPLO is a truly amazing thing in terms of how it works from a mechanics standpoint)
- what kind of pain control methods do they use (at least pre-op sedation and intra and post-op analgesia, plus a Fentanyl (or comparable) patch for a day or two, plus pain medication to go home with (opiates plus NSAIDs or comparable). It has been reliably shown that animals recover faster and better if they experience as little pain as possible (just like people), if they tell you that the dog "needs to feel pain" in order to keep quiet, go somewhere less barbaric, many of the pain meds used after major surgeries also have a sedating effect, so there is no need to allow a dog to experience pain post-op.
- what kind of anaesthetic monitoring do they employ (anything less than a dedicated tech anaesthetist and vet assistant responsible for monitoring would concern me - I have seen the levels of monitoring which are available and utilized in the more modern clinics, and I would not have a dog of mine put under anywhere that doesn't have someone whose ONLY job is to monitor vitals and anesthesia levels during the procedure, especially with an older dog). They should at least use a heart monitor and O2 sat monitor, and they should be taking regular blood pressure readings during the procedure.
- can they talk to you/give you a handout regarding post-surgical care so that you can plan appropriately beforehand?
- do they offer/recommend rehabilitation post-op (if not, I would worry)
- they should talk to you about (and you should do your own research into) CareCredit, for big-dollar procedures, you can get no interest for a year in many cases.
Good luck.
More info here.
posted by biscotti at 10:22 PM on September 26, 2007 [2 favorites]
This thread is closed to new comments.
Good luck!
posted by DarlingBri at 7:42 PM on September 26, 2007